I read with interest Dr. Claas Lahmann and colleagues’ March JADA article, "Brief Relaxation Versus Music Distraction in the Treatment of Dental Anxiety" (Lahmann CL, Schoen R, Henningsen P, et al. JADA 2008;139[3]:317–324).
The "thematic structure of brief relaxation therapy," as described by the authors, includes a progressive relaxation hypnotic technique. Many hypnosis texts cover this subject. Two such texts are Kroger’s Clinical and Experimental Hypnosis in Medicine, Dentistry and Psychology,1 and Erickson’s The Practical Application of Medical and Dental Hypnosis.2
When the JADA authors talk about "gravity" and suggest patients "move like a snake," they are employing the visual imagery conditioning described in Kroger and Fezler’s text, Hypnosis and Behavior Modification: Imagery Conditioning.3 Hartland, in Medical and Dental Hypnosis and Its Clinical Applications,4 also discusses progressive relaxation and imagery. In the chapter titled, "The Uses of Hypnosis in Dental Surgery," Tinkler writes about "the time-factor in dental hypnosis." He says, "It is my practice to devote no more than three sessions to attempting to induce hypnosis. If satisfactory progress is not made within 3 to 5 minutes on each of three separate occasions ..." he does not use formal hypnosis with that patient. These three-to five-minute talks can be given while the dentist waits for local anesthesia, so the technique is not time-consuming in any sense.
The greatest advantages of hypnosis to the dentist are the calm atmosphere within the office and the time saved working with patients. The stress-free environment is a practice-builder and saves "stomach lining" for the dentist and staff. Satisfied patients refer new patients. The time spent training patients is returned many times over. Even if an hour is spent training a patient how to relax, the subsequent shorter visits associated with a calm, relaxed patient ultimately will increase productivity for the dentist.
For many years, the USC School of Dentistry has given programs about the dental use of hypnosis. Courses are given for undergraduate students, as well as for postgraduate continuing education.
"Brief Relaxation" is a euphemism for hypnosis. Dentists should have knowledge of relaxation techniques. I applaud Dr. Lahmann and colleagues for their efforts to bring an under-used technique to the attention of the dental profession. Hypnosis is a practice-builder and, simultaneously, increases the productivity of those who use it.
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